LE RIUNIFICAZIONI FAMILIARI: STUDIO SULLE ATTIVITA' DEI SERVIZI DI TUTELA MINORI IN EMILIA-ROMAGNA

Il lavoro di tesi ha come oggetto di studio gli interventi di collocamento etero-familiare dei minori, in affidamento familiare e in comunità educativa, realizzati dai Servizi sociali in Emilia-Romagna, nel periodo 2008-2012. Sono stati analizzati i dati provenienti dal sistema informativo regionale, relativi ad 8.438 minori. Il lavoro si compone di tre parti: la prima è un’analisi descrittiva delle caratteristiche dei minori del campione e dei diversi interventi effettuati. Nella seconda parte, assumendo la prospettiva della family reunification, si intende osservare l’effettivo percorso dei minori, in termini di miglioramento o di peggioramento delle condizioni di partenza, al di là del rientro in famiglia. Allo scopo sono state create delle tipologie di esito e delle tipologie di processo, attraverso cui definire ciascun percorso. E’ stata quindi effettuata l’analisi descrittiva degli esiti e dei processi presenti all’interno campione. Nell’ultima parte del lavoro, è stata effettuata un’analisi statistica, volta ad individuare correlazioni significative tra le tre variabili rappresentate dalle tipologie di collocamento, dagli esiti e dai processi e le caratteristiche dei minori, le problematiche prevalenti dei minori e le problematiche prevalenti dei nuclei familiari. Le stime effettuate attraverso tabelle a doppia entrata sono state corrette tramite modelli di regressione di probabilità lineare.The aim of the study is to examine out-of-home placements for children in Child Protection System, both in foster and in residential care, in Emilia-Romagna, in the period 2008-2012. Data are collected by the regional information system and the sample includes 8,438 children. The work consists of three parts: the first is a descriptive analysis of the characteristics of the children and of the different interventions. In the second part, taking the perspective of family reunification, we intend to observe the actual path of the child, in terms of improvement or deterioration of conditions departure, beyond the return to the family. Some types of outcomes and some types of processes have been individuated. It was then performed the descriptive analysis of the outcomes and processes present in the sample. In the last part of the work, it was carried out a statistical analysis in order to identify significant correlations between the three variables represented by the types of placements, the outcomes and the processes and characteristics of the children, the prevalent problems of children and the problems prevailing household. Estimates made through double entry table have been corrected by linear regression models of probability

Livourne, ville de la diversité : un concours d’idées pour l’aménagement d’une zone portuaire

Au printemps 2015, plus de 500 ans après la fondation de Livourne, l’association Livorno delle diversità (Livourne des diversités) - née en 2014 avec l’objectif de propager l’idée que le respect de la diversité dans le quotidien est une condition essentielle pour vivre - s’empare d’une problématique urbaine relative tant au passé qu’au présent de la ville. Cela l’amène à mettre en place une procédure de concours d’idées artistiques pour l’aménagement d’une zone portuaire à travers la mise en place d’une installation artistique dans le port de Livourne. Cette dernière devra rappeler l’importance de la diversité en tant que condition de la vie quotidienne, rendant hommage au principe actuel de la laïcité institutionnelle mais aussi à la tradition d’accueil de la ville. Fondée par la famille des Médicis du grand-duché de Toscane au XVIe siècle avec l’intention d’en faire une ville cosmopolite, où la cohabitation entre peuples de langues et de religions différentes vise à faciliter l’afflux de personnes, et de donner ainsi une grande impulsion aux échanges commerciaux, Livourne base, depuis toujours, son économie sur la présence du port. La demande de l’association à l’autorité gérant le port d’y placer l’installation témoigne de l’importance que celui-ci continue à avoir. Ce concours d’idées a rassemblé divers acteurs locaux (autorité du port, mairie, monde associatif, ordre des architectes, habitants…) concernés par les thèmes de l’accueil, de la cohabitation et, plus généralement, du rapport entre le port et la ville et a permis aux habitants de contribuer au choix du lauréat, à travers des modalités de consultations directes. Le projet, encore en cours de réalisation, doit faciliter l’intégration ville-port et le respect des normes essentielles de la cohabitation.In the spring of 2015, more than 500 years after Livorno was founded, the association Livorno delle diversità – set up in 2014 with the objective of spreading the idea that respect for diversity is an essential condition of everyday life - addressed an urban problem relating to the city’s past and present. This led to the association organising a competition for the best artistic ideas for the development of a port area through the installation of a work of art in the port of Livorno. This installation was intended to provide a reminder of the importance of diversity as an essential condition of everyday life, to promote the notion of institutional secularism, and to pay tribute to the city's tradition of hospitality. The city was founded by the Medici family from the Grand Duchy of Tuscany in the 16th century. The ambition at the time was to build a cosmopolitan city, the idea being that the coexistence of people of different nationalities with different languages and religions would facilitate the influx of visitors and boost trade. Livorno has always based its economy on the presence of the port. The request by the association made to the port authorities to place the installation there bears witness to the continued importance of the port. This competition brought together different local actors such as the port authorities, town hall representatives, local associations, the guild of architects, and the inhabitants; all of whom are stakeholders concerned by the issues of integration, cohabitation and, more generally, the interrelations between the port and the city. The competition allowed the inhabitants to directly take part in the selection of the winning project through a consultation procedure. The project, which is still in progress, should facilitate city-port integration and integrate essential factors fostering cohabitation

Progettare percorsi di cura e assistenza: il confine tra autodeterminazione e protezione

L’articolo tratta il tema delle funzioni di supporto degli operatori sociali nei confronti degli anziani e delle loro famiglie. Il punto di vista a partire dal quale si articola la riflessione è quello dell’assistente sociale, capace di portare alla luce i principali nodi critici nonché i possibili spazi di intervento e miglioramento della progettazione dell’assistenza

Hepatitis B virus DNA integration in tumour tissue of a non-cirrhotic HFE-haemochromatosis patient with hepatocellular carcinoma.

Co-existence of multiple causes of liver injury increases the risk of hepatocellular carcinoma (HCC) development. HCC usually develops in patients with cirrhosis although it may also occur in individuals with no or mild liver disease, in particular in cases with hepatitis B virus (HBV) infection. Here we report the case of a 43year-old man with HFE-haemochromatosis, seronegative for hepatitis B and C infections, who developed HCC in the absence of severe liver damage. Both tumoural and non-tumoural liver DNA extracts were tested by nested-PCR and primers specific for four different HBV genomic regions in order to evaluate the presence of occult HBV infection. Only X gene sequences were detected in tumour (but not in non-tumour) DNA extracts. HBV-Alu PCR showed a HBV integration involving a 5'-deleted X gene with an intact enhancer-II/basal-core promoter region. The viral-host junction sequencing revealed that this integrant was located upstream of the partitioning-defective-6-homolog-gamma gene (PARD6G) and real time-PCR quantification demonstrated that PARD6G was overexpressed in tumour compared to non-tumour liver tissues. In conclusion, the combination of HFE-haemochromatosis and occult HBV infection in this patient might have led to a sequel of cellular events that determined the development of HCC even in the absence of cirrhosis

Fluctuations of estimated glomerular filtration rate outside kidney disease improving global outcomes diagnostic criteria for acute kidney injury in end-stage liver disease outpatients and outcome postliver transplantation

Background. Renal dysfunction in end-stage liver disease (ESLD) results fromsystemic conditions that affect both liver and kidney with activation of vasoconstrictor systems. In this setting, estimated glomerular filtration rate (eGFR) may undergo variations often outside Kidney Disease Improving Global Outcomes criteria for acute kidney injury (AKI) diagnosis, whose meaning is not clear. The aim of this study was to evaluate eGFR variations in ESLD outpatients listed for liver transplant (liver Tx) and the association with post-Tx outcome. Methods. Fifty-one patients with ESLD were retrospectively evaluated from listing to transplant (L-Tx time), intraoperatively (Tx time), and up to 5 years post-Tx time. Variations between the highest and the lowest eGFR occurring in more than 48 hours, not satisfying Kidney Disease Improving Global Outcomes guideline, were considered as fluctuations (eGFR-F). Fluctuations of eGFR greater than 50%were defined as eGFR drops (DeGFR). Early graft dysfunction, AKI within 7 days, chronic kidney disease, and short- and long-term patient survivals were considered as outcomes. Results. All patients presented eGFR-F, whereas DeGFR were observed in 18 (35.3%) of 51 (DeGFR+ group). These patients presented higher levels of Model for End-stage Liver Disease score, pre-Tx bilirubin and significantly greater incidence of post-Tx AKI stages 2 to 3 compared with patients without drops (DeGFR−). DeGFR was the only independent predictive factor of the occurrence of post-Tx AKI. The occurrence of AKI post-Tx was associated with the development of chronic kidney disease at 3 months and 5 years post-Tx. Conclusions. Drops of eGFR are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome

Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study

The study's aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0-18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery

Gut microbiota markers in obese adolescent and adult patients: Age-dependent differential patterns

Obesity levels, especially in children, have dramatically increased over the last few decades. Recently, several studies highlighted the involvement of gut microbiota in the pathophysiology of obesity. We investigated the composition of gut microbiota in obese adolescents and adults compared to age-matched normal weight (NW) volunteers in order to assemble age- and obesity-related microbiota profiles. The composition of gut microbiota was analyzed by 16S rRNA-based metagenomics. Ecological representations of microbial communities were computed, and univariate, multivariate, and correlation analyses performed on bacterial profiles. The prediction of metagenome functional content from 16S rRNA gene surveys was carried out. Ecological analyses revealed a dissimilarity among the subgroups, and resultant microbiota profiles differed between obese adolescents and adults. Using statistical analyses, we assigned, as microbial markers, Faecalibacterium prausnitzii and Actinomyces to the microbiota of obese adolescents, and Parabacteroides, Rikenellaceae, Bacteroides caccae, Barnesiellaceae, and Oscillospira to the microbiota of NW adolescents. The predicted metabolic profiles resulted different in adolescent groups. Particularly, biosynthesis of primary bile acid and steroid acids, metabolism of fructose, mannose, galactose, butanoate, and pentose phosphate and glycolysis/gluconeogenesis were for the majority associated to obese, while biosynthesis and metabolism of glycan, biosynthesis of secondary bile acid, metabolism of steroid hormone and lipoic acid were associated to NW adolescents. Our study revealed unique features of gut microbiota in terms of ecological patterns, microbial composition and metabolism in obese patients. The assignment of novel obesity bacterial markers may open avenues for the development of patient-tailored treatments dependent on age-related microbiota profiles

Serum Thymus and Activation-Regulated Chemokine Level Monitoring May Predict Disease Relapse Detected by PET Scan after Reduced-Intensity Allogeneic Stem Cell Transplantation in Patients with Hodgkin Lymphoma

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Hyperferritinemia and diagnosis of type 1 Gaucher disease

Given the difficulties in diagnosis of type 1 GD in adults because of disease heterogeneity and lack of awareness, appropriate diagnostic algorithms or flow-charts starting from non-specific findings may help. Case reports help to establish the usefulness of our proposed flowchart in patients presenting with \u201cunexplained hyperferritinemia\u201d

The role of positron emission tomography with 18F-fluorodeoxyglucose integrated with computed tomography in the evaluation of patients with multiple myeloma undergoing allogeneic stem cell transplantation

Positron emission tomography (PET) integrated with computed tomography (PET/CT) has been reported to be useful for screening myelomatous lesions at diagnosis in patients with multiple myeloma (MM) and for monitoring response to autologous stem cell transplantation (auto-SCT). The aim of the study was to evaluate the prognostic significance of PET/CT in MM patients who received allogeneic stem cell transplantation (allo-SCT). Patients who underwent upfront auto-SCT followed by allo-SCT, either as consolidation or salvage treatment, were studied with PET/CT before and/or within 6 months after allo-SCT. The number, the maximum standard uptake value (SUV), and the location (medullary or extramedullary) of focal lesions (FLs) were recorded and investigated as predictors of progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. Fifty-four patients had a PET/CT scan before allo-SCT. Of these, 22 patients (41%) had a negative PET/CT scan, 11 patients (20%) showed 1 to 3 FLs, and 21 patients (39%) had either a diffuse bone marrow involvement or more than 3 FLs. SUV was >4.2 in 21 patients (39%) and extramedullary disease (EMD) was present in 6 patients (11%). Multivariate analysis of prognostic factors before allo-SCT showed that persistence of EMD at transplantation was an independent predictor of poor PFS, whereas OS was negatively influenced by unrelated donor and SUV > 4.2. Fifty-nine patients had a PET/CT scan within 6 months after allo-SCT. Multivariate analysis of post-treatment variables showed that persistence of EMD and failure to obtain complete response or very good partial response after allo-SCT were strongly associated with shorter PFS and OS. Of the 46 patients with evaluable PET/CT scans both before and 6 months after allo-SCT, the 23 patients who maintained or reached a PET complete remission showed a significantly prolonged PFS and OS compared with the 23 patients with persistence of any PET positivity (2-year PFS: 51% versus 25%, P = .03; 2-year OS: 81% versus 47%, P = .001). This study indicates that PET/CT imaging before and after allo-SCT is significantly associated with the outcome, suggesting the utility of this technique for MM staging before allo-SCT and for response monitoring after the transplantation